Asthma

New burning in airway/sensation of dyspnea

10/23/2008

Question:

I have GERD (different burning).My asthma(intrinsic+extrinsic) by allergist+PFTs+pulmonologist have initiated treatment more aggessively when asthma became more problematic than over the previous 30 year (I am 53).Since Sept.have been on steroids 3 times for burning airway/more mucus/feel like can`t get air in/SOB.Repeat CXR stable from Feb.(hyperinflated lungs/flattened diaphragm/air trapping).Pulse ox 96.Breathing test in pulmonologist office told me exhaled 120% of lung volume but I don`t know what that means.He inquired about my fibro (which is flared up but I`d never had fibro affect my lungs/airway before).I have good repsonse with steroids but pulmonologist said steroids help fibro,too.He never thought bronchoscopy in order to look at inflammation based on other findings.Can fibro cause resp.distress in asthmatic? Have had CTs to R/O PE and to define nodule on one lung.Is CXR suggestive of emphysema (some docs have thrown that word out with me, others use COPD, others, `just asthma` so I am confused).I have made an appointment w/rheumatologist with earliest appt.late Dec.By then steroids will by out of system (saved meds I take--Singulair,Spiriva,Pulmacort,allergy pill,rescue inhaler,Prilosec OTC).Thanks so much.

Answer:

I'm unable to give you specific information or recommendations in this forum; however, I can give general information that may be helpful to you.

1. Esophageal burning can be caused by uncontrolled acid reflux (even on acid reducing medications); infections such as thrush in the esophagus caused by steroids; or the medications themselves causing a local irritation.

2. Shortness of breath and the sensation of difficulty getting air into the lungs can be a symptom of asthma but is more commonly associated with an upper airway problem like vocal cord dysfunction (VCD). VCD can mimic asthma in those who do not have asthma or occur along with asthma and give the picture of "worsening" asthma. VCD is worsened by anything that irritates the vocal cords such as acid reflux, post nasal drip, medications especially the powder formulations or stress/anxiety. The condition is diagnosed by ENT using a small scope. You can get more information by researching on this site.

3. Flattened diaphragm and hyperinflated lungs on xray typically represent air trapping or obstruction. Generally this is seen more often with emphysema or chronic bronchitis but can occur with asthma. We refer to people with evidence of air trapping/chronic obstruction as having Chronic Obstructive Pulmonary Disease (COPD). Asthmatics can develop remodeling of the airways after many years with asthma which causes less flexibility and less response to medications in the airways. As a result, they can develop chronic obstruction. Additionally, people with asthma can also have emphysema from prior exposures such as smoking.

4. You mention fibro. I assume you are referring to fibromyalgia. I do not know of any association between fibromyalgia and lung problems.

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